AB1197 ANTIDEPRESSANTS TREATMENT AND SEVERITY OF PAIN IN RHEUMATOID ARTHRITIS PATIENTS WITH ANXIETY AND DEPRESSIVE DISORDERS
Authors: A. Abramkin, T. Lisitsyna, D. Veltishchev, O. Seravina, O. Kovalevskaya, S. Glukhova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Background Anxiety and depressive disorders (ADD) significantly affect disease activity and pain modulation in rheumatoid arthritis (RA) patients. Psychopharmacotherapy (PPT) of ADD attempts to improve RA disease activity and manage pain in RA patients. Objectives To determine factors associated with intensive pain syndrome in antidepressants-treated RA-patients at five years endpoint. Methods 128 RA-patients (pts) were enrolled, 86% were women with a mean age of 47,4±11,3 (M±SD) yrs. All patients met the full ACR/EULAR 2010 criteria for RA. Disease activity was assessed using DAS28, pain severity – using Brief Pain Inventory scale (BPI). Severe Pain was defined as BPI Worst Pain Score (BPImax) from 7 to 10. 69,4% RA-pts were already taking prednisone (9 [5; 10] mg/day (Me (25%; 75%)), 84,4% - cDMARDs, 7,8% - bDMARDs (anti-TNF-α – 6,3%, rituximab – 1,6%). Biologics treatment duration varied from 1 to 6 years, antidepressants – from 6 to 96 weeks. ADD were diagnosed by psychiatrist in 123 (96,1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-pts with ADD were divided into the following treatment groups: 1 – сDMARDs (n=39), 2 – сDMARDs + PPT (sertraline or mianserine) (n=43), 3 – сDMARDs + bDMARDs (n=32), 4 – сDMARDs + bDMARDs + PPT (sertraline or mianserine) (n=9). Baseline BPImax by groups was as follows: 4,82±2,1, 5,85±2,06, 5,5±2,1, 7,57±2,17, respectively (p1-4&lt;0,001; p2-4=0,048; p3-4=0,013). Multivariate logistic regression was used to determine predictors of severe pain. Results At five-years follow-up pain severity was assessed in 74 out of a total of 83 patient. By univariate logistic regression, baseline age, HAQ, CRP, DAS28 and BPImax, presence of extraarticular manifestations, cardiovascular diseases, cognitive impairments and schizotypal personality disorder, lower HADS for anxiety, no remission of anxiety or depression at five years and no history of glucocorticoids usage were significantly (p≤0,3) associated with severe pain at five-years follow-up (Table 1). These variables were subjected to multivariate stepwise logistic regression. Only extraarticular manifestations at baseline (OR 4,01 (95%CI 0,96 – 16,77), p=0,057), no history of glucocorticoids usage (OR 0,15 (95%CI 0,04 – 0,56), p=0,005) and nonremission of anxiety and depressive symptoms at 5-yrs (OR 0,11 (95%CI 0,019 – 0,668), p=0,016) were independently associated with severe pain at 5-years follow-up (R2=0,406, sensitivity 38,5%, specificity 92,7%). Table 1. Factors associated with severe pain at 5 years (univariate logistic regression). Factor p OR 95%CI low up Baseline age ,129 1,047 ,987 1,112 Baseline HAQ ,056 2,155 ,981 4,734 Baseline DAS28 ,075 1,361 ,969 1,911 Baseline CRP ,151 1,011 ,996 1,026 Baseline BPImax ,083 1,269 ,970 1,662 Extraarticular manifestations at baseline (yes/no) ,027 4,278 1,179 15,517 Cardiovascular diseases at baseline (yes/no) ,259 2,111 ,577 7,718 Cognitive impairments at baseline (yes/no) ,218 2,758 ,549 13,860 Schizotypal personality disorder ,085 3,733 ,834 16,715 HADS anxiety ,259 ,904 ,758 1,077 Anxiety and depressive symptoms remission at 5-yrs endpoint ,102 ,313 ,077 1,261 History of glucocorticoids usage (yes/no) ,025 ,234 ,066 ,833 Conclusion RA patients with severe pain should be routinely screened for anxiety and depression, and in patients with probable ADD consultation with a psychiatrist and prescription of antidepressants should be considered. Disclosure of Interests None declared